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Regulation may distract healthcare professionals from good patient care

Posted on 20/10/2009
Research conducted by Royal Holloway, University of London and King’s College London has found that regulation may distract NHS professionals and organisations from providing safe and effective patient care. The research suggests that the future regulation of psychotherapists and counsellors by the Health Professions Council must avoid having the same effect.

The study, funded by the General Medical Council and the Economic and Social Research Council (ESRC) Public Services Programme, examined the way that NHS doctors and therapists, including those in an Improving Access to Psychological Therapies (IAPT) service, said that current forms of regulation affected their clinical work.

Dr Gerry McGivern, from King’s, explains, “The experience of doctors and therapists highlights a number of unintended effects of regulation which adversely affect patient care. Responding to high-profile media spectacles and expanding bureaucracy has created a regulatory climate obsessed with blame, which doctors describe this as “hell” and “reminiscent of the Inquisition”, undermining professional practice, patient safety and care.”

The research delves into the often hidden ways in which regulation is influencing clinical practice in medicine and psychotherapy. Dr Mark Exworthy, from the School of Management at Royal Holloway, says, “Greater openness in managing professionals may have some benefits but it also carries the risk of unintended side-effects. At a time of rising concern amongst the public and growing interest by policy-makers, we hope that this research will have significant effects in shaping the ways in which professionals will be regulated in the future.”

The report is based on a research project entitled ‘The Visible and Invisible Performance Effects of Transparency in Professional regulation’, which compared the visible and invisible performance effects of transparency in the regulation of two professions discussed in the ‘2007 White Paper Trust, Assurance and Safety: The Regulation of Health Professionals’: medical professions, a well established and statutorily-regulated profession, with a large evidence-based against which to assess practice; and the psychotherapy/counselling profession, a developing profession, with a weak knowledge-base and no statutory regulation.

“We do not claim that our findings are representative of the whole field of psychotherapy and counselling,” comments Professor Ewan Ferlie, from King’s. “However, our research does reflect how regulation is perceived in different contexts, so it may indicate how future statutory regulation would be interpreted and implemented in practice. Politicians need to balance reacting to rare but high-profile cases of malpractice by introducing new layers of regulation, with its often-detrimental impact the majority of health professionals, and its enormous financial costs.”

The experts offer a number of recommendations, including the need for: professional regulation to balance reacting to high profile but rare ‘media spectacles’ with its actual impact on the majority of practitioners’ clinical practice; the provision of ‘formative spaces’ for professionals, such as clinical supervision, in which to discuss complex and challenging issues, for patient care to be safe and effective; and for healthcare organisations to avoid crowding-out good clinical care through legal bureaucracy and excessively focus on outcome measures. The authors of the report argue that since professional engagement is essential to making regulation work, mandatory professional regulation may be a more effective means of improving patient care and protecting the public than imposing statutory regulation on reluctant professionals who cannot see its benefits in practice.

For further information about the research project, visit: http://www.publicservices.ac.uk/research/the-visible-and-invisible-performance-effects-of-transparency-in-medical-professional-regulation/


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